Beruflich Dokumente
Kultur Dokumente
Carol Berg
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Developmental
dysplasia of Hip
Dr Waqar Hassan
TMO Orthopedic Unit
HMC
Objectives
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Definition
DDH is a spectrum of disorders. Hip
can be
Dislocated
Dislocatable
Subluxated
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Age
1. Teratological Dislocation
(congenital dislocation of hip)
Typical DDH
Child is otherwise normal
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Epidemiology
& risk factors
• Incidence 1 in 1000 live birth
• Left hip 67%
• Family history 20%
• In breech 30-50%
• Bilateral 35%
• Sex Ratio (Relaxin) F(4 - 6) : M(1)
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Risk factor
Environmental & Mechanical
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Risk factor
Genetic
unknown genetic factor
Runs in families
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Nursing
race
Rare in China, Asia, Africa (carry
children with hips flexed and
abducted)
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Aetiology-Ligamentous
Laxity
Maternal Relaxin hormones
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1818
Pathology
Bone
Soft tissues
Muscles
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Screening for DDH
Methods
Clinical
U.S. Scan
Aim of screening
Early
detection
Reduces late presentation
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Clinical screening
Standard programme
Barlow’s/Ortolani’s tests done on
every child at birth and then at 6-8
weeks
Barlow’s/Ortolani’s Tests
Specificity- 100%
Sensitivity- 60%
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Barlow Provocative Test
in neonate
Dislocates hip
(exit)
Clunk
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Ortolani Maneuver
in neonate
Reduces
Abduction
dislocated hip
(entry)
Clunk
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Infant >3 Months
57º 43º
Asymmetric
thigh folds
Limb-length
discrepancy
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Galeazzi test
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Toddler
Limping
waddling gait
Lordosis
Deformity
Limited abduction and lateral rotation
Telescoping
Leg length discrepancies
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Ultrasound Screening
High Specificity and Sensitivity: >90%
frog-leg views
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Central edge
angle
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Von Rosen’s line
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Treatment
Aim
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According to Campbell’s
operative orthopedics
birth to 6 months (New born)
6 to 18 months (Infant)
18 to 36 months (toddler)
3 to 8 years (child)
Juvenile & Young adults-
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TREATMENT :
In newborn
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Denis Brown Abduction
Splint
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Von Rosen Splint
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Pavlik harness should not be
continued for more than 4 weeks if
failed
Complication
AVN
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Treatment: Infant 6 to 18
months
Closed reduction & Spica
Must be gentle flex hip > 90
degree and in safe zone of 30 -60
degree abduction
Arthrography is often useful
Adductor tenotomy
Open reduction if necessary
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Hip spica
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Aftercare
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Open reduction in 12 to 18
months
As child get older chance of
successful close reduction
decrease
Open reduction may be needed
due to soft tissues contracture
Seldom need bony procedure
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Open reduction
Structural obstacles to close
reduction are
Hour glass capsular contracture
Ligamentum teres
Iliopsoas
Pulvinar
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Toddler 18-36months
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Child 3 to 8 years of age
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Oteotomy
Femoral osteotomy
Femoral shortening
Derotation
Varus
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Pelvic Osteotomies
Reconstructive
Salter 18m – 6y
Pemberton 18m – 10y
Steel skeletal maturity
PAO (Ganz) skeletal maturity
Salvage
Chiari skeletal maturity
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Overview of Pelvic
Osteotomies
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How to determine for
osteotomy
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Juvenile & Young adults
> 8 years
Palliative salvage procedures
Rarely femoral shortening &
pelvic osteotomy
Bilateral: leave it alone
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Researh work in our unit
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Study in orthopedic unit
HMC
Period : Sep2003 to July 2007
Ref no. : JPMI 2008 VOL22
NO.01:27-32
Title : One stage surgery of
CDH/DDH in children of
2-5 years of age
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Results
Total no. of patients: 25
Total hips operated: 30
Gender :
Female: 17
Male: 8
Bilateral : 5 Cases
Left side : 18 cases
Mean age at surgery: 38.56
months
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Radiological assessment
modified Severin classification
Excellent IA CE angle>19 degree 9
Poor IV Subluxation 0
V Head In false acetabulum 0
Redislocation 0
VI
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Functional results
modified MCKAY criterion
Grade No. %
of age
hip
s
Excellent Stable, no limp, full ROM , -ve trendlenberg 18 60
Sabiha
4 yr old
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Case -2
Irtiza
2 yr old
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Case-3
Alia
2 yr old
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75
76
Case- 4
Faiza
2 yr old
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Conclusion
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Suggestion
Radiologist
Pediatrician
Gynecologist
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THANK YOU
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Ultrasound
I >60 Normal
II 60-43 Immature/Dysplastic
IV Unmeasurable Dislocated